Web Only / Features » November 1, 2013

The Real Problem with Obamacare

Back when Obamacare was being negotiated, Congress could have circumvented the private insurance industry by simply expanding Medicare to cover everybody. Medicare isn't perfect, of course, but it remains one of the most popular institutions in America because its single-payer model guarantees access to decent, cost-effective healthcare rather than just meager health insurance.

Whenever scandal arises in Washington, D.C., the fight between the two parties typically ends up being a competition to identify a concise message in the chaos—or, as scientists might say, a signal in all the noise. This week confirms that truism, as glitches plagued the new Obamacare website and insurance companies cancelled policies for many customers on the individual market.

Amid the subsequent noise of congressional debate and cable TV outrage, Republicans argued that the signal is about government—more specifically, they claim the controversies validate their age-old assertions that government can't do anything right. Democrats countered that the signal in the noise is about universal healthcare—Obamacare is a big undertaking, they argue, and so there will be bumps in the road as the program works to provide better health services to all Americans.

This back and forth is creating an even more confusing cacophony—and further obscuring the signal that neither the two parties nor their health industry financiers want to discuss. That signal is about the need for single-payer healthcare—otherwise known as Medicare for all.

One way to detect this signal is to consider the White House guest list.

In trying to show that he was successfully managing the Obamacare roll out, the president last week staged a high-profile White House meeting with private health insurance executives—aka Obamacare's middlemen. The spectacle of a president begging these middlemen for help was a reminder that Obamacare did not limit the power of the insurance companies as a single-payer system would. The new law instead cemented the industry's profit-extracting role in the larger health system—and it still leaves millions without insurance.

The second way to see this single-payer signal is to behold the Obamacare-related congressional hearings. During the proceedings, you've been hearing a lot about the insurance enrollment website that the government is paying millions to insurer UnitedHealth Group to build. But you're not hearing much about actual healthcare. That's because the insurance industry wrote the Affordable Care Act, meaning the new statute's top priority isn't delivering health services. Obamacare is primarily about getting the insurance industry more customers and government contracts, whether or not that actually improves health services.

The third way to see this single-payer signal is to simply experience the confusion about Obamacare for yourself.

If you've managed to successfully log onto Healthcare.gov, you probably have been treated to a wave of perplexing information about different kinds of private insurance plans and premiums. In other words, you haven't seen a simple, standardized and guaranteed form of healthcare coverage like the kind provided by the single-payer government-administered Medicare system. You've likely seen the same maddeningly labyrinthine private insurance system that works to ration—and often deny—access to healthcare.

It didn't have to be this way. Back when Obamacare was being negotiated, Congress could have circumvented the private insurance industry by simply expanding Medicare to cover everybody. Medicare isn't perfect, of course, but it remains one of the most popular institutions in America because its single-payer model guarantees access to decent, cost-effective healthcare rather than just meager health insurance. It also does a good job of preventing profit-taking middlemen from getting between patients and their physicians.

Obamacare doesn't do all that. It certainly includes some important reforms, but it doesn't do what a single-payer system does—it doesn't guarantee better healthcare or a more simple health system.

Those Democrats who pretend it does are just as dishonest as the Republicans who ignore Medicare and pretend government cannot effectively manage healthcare. All of them are making noise to drown out the single-payer signal.

David Sirota, an In These Times senior editor and syndicated columnist, is a staff writer at PandoDaily and a bestselling author whose book Back to Our Future: How the 1980s Explain the World We Live In Now—Our Culture, Our Politics, Our Everything was released in 2011. Sirota, whose previous books include The Uprising and Hostile Takeover, co-hosts "The Rundown" on AM630 KHOW in Colorado. E-mail him at ds@davidsirota.com, follow him on Twitter @davidsirota or visit his website at www.davidsirota.com.

Messaging concept: Quit saying "single payer," there's no such thing. I pay for Medicare and so do you, along with tens of millions of workers and employers. It's a *multiple* payer system. That phrase gets rid of the "big gummint monopoly" baggage that "single payer" carries. Multiple-payer also more accurately describes how we, collectively, can take responsibility for the health and welfare of *all* of our citizens. Just like every other civilized country.

Posted by Roger Kerson on 2013-11-06 13:56:37

10s of millions are listening to FAUX SPEWS.... They really are getting a better deal, but I am not sure about the prices... Just remember this, over 50% of the people in this country have their healthcare paid for by the governments.... Think about the government employees, the contractors, the military, medicaid and medicare.... The reason WALL STREET is fighting this is because they do not want the 50% who are not covered by government reimbursement to know how GREEDY they are....They will never let go of one penny of profit without fraud, lying and deciet....

Posted by schatsie on 2013-11-06 08:43:23

Interesting comment,,, Cover means that you have to pay for it out of your deductible... Free is a different term, means that the insurer pays for that regardless of the deductible and coinsurance and copays.... I worked for an insurance company for 10 years and the lack of clarity and the obfuscation was overwhelming....

Posted by Schatsie on 2013-11-06 08:39:27

The Clinton Plan was much closer to "single payer" and the private health insurance industry killed it. An industry with the economic power of the private health insurance industry has the power to control the government and force it to do what the industry wants. The only reason Medicare exists (and Medicaid) is because the industry saw no profit in providing health insurance to these groups. Also the Democrats of that era were more hostile towards businesses like the insurance industry.

Posted by Jerome Bigge on 2013-11-04 17:37:04

I don't agree that the ACA does not address actual healthcare. It does and it does in several ways. It makes certain types of preventative care free, including vaccination, the most powerful way to prevent sickness and death that modern medicine has to offer. It covers contraception, pregnancy and childbirth to make sure that the newborn has a good start in life and a woman's health is protected. It requires medical records to be computerized so that in a system where several providers are caring for one patient, they can better coordinate their efforts. Computerization should also uncover epidemiological information so that researchers can uncover the best or ineffective practices. Finally, by protecting the insured from becoming dropped or hitting ceilings of coverage, continuous care is insured resulting in better health outcomes. https://www.facebook.com/Chris...

This means, like myself, you are not normal. In any country, in any times there may be as many as 2% of the population who know what is really happening politically.

Posted by Chris Herz on 2013-11-03 13:13:41

What happens when the vampires have sucked the life from society?

Posted by Pelu Maad on 2013-11-03 11:49:03

I have no trouble working up the proper level of cynicism but I'm routinely chastised for it by people who, after a few years, say that they hate to admit it but that I was right.

Does their critical eye adjust to what they've realized? Nope, some folks just gotta believe - the alternative is too despairing.

Posted by brunssd on 2013-11-03 11:38:07

I want everyone to hear my story:

I just went onto the governments healthcare website and signed up with no problems, it took me 10 minutes.. Was able to navigate and compare plans with no problems.. Being able to adjust my families needs was a SNAP!! .. After I made my selection, I went to the 'cashiers' page and had no problem making my payment.. My old insurance plan I lost years ago was nice, but the one I signed up for today was HEADS and tails above what I had....... AND CHEAPER!!

I shouldn't sound so happy.. Me and my family have been blessed.. Neither I, nor my wife and 5 children have ANY medical problems (not bad for someone 38 years old, ah?).. I am just so happy a program like this came along..

I hope everyone realizes what kind of 20 MILLION real life stories like this NEED to ACTUALLY be true for DEMO-Care to really work.. Good luck.. It was fun to get DEMOs hopes up for 5 seconds to think they actually found ONE person..

Posted by Bill Smith2 on 2013-11-03 09:53:51

Well, I guess we just wait until the economy craps out again as it will. And when employers start either dumping healthcare to save money or start making their employees pay for more and more of it, we'll see how many people start thinking better of single payer! BTW, how many of our military personal do you hear complaining about their socialist healthcare?

Posted by Z54 on 2013-11-03 08:38:31

"A New York Times/CBS News poll released last week shows, yet again, that the majority of Americans support national health insurance.

The poll, which compares answers to the same questions from 30 years ago, finds that, “59% [of Americans] say the government should provide national health insurance, including 49% who say such insurance should cover all medical problems.”

There isn't public support for it, too many Americans keep saying they like their insurance company. If there was a poll saying that 80% of Americans wanted single payer, we would know, there isn't, I bet it's under 40%. Forget it, what a waste of time. Okay, single payer would be the best, so what, how boring.

Posted by OH on 2013-11-02 23:24:09

The tens of millions of Americans who continue to insist they like their health insurance is a problem for single payer. You can't have public support without public support, and you don't have public support, it doesn't matter whether you have public support in theory if you don't have it for real. Public support does not mean that people would support you if only they knew you were right. There is far more actual public support for legalized marijuana than there is for single payer.

Posted by OH on 2013-11-02 23:21:14

Single-payer was taken off the table from the start by Obama and Rahm. They'd already made the grand bargain with the insurance companies. It was actually passed in the House (under Pelosi) and would have passed in the Senate, until Obama visited Reid the nite before the vote.

Posted by breezy on 2013-11-02 19:10:24

Until it is no longer profitable.Actually, it is not profitable now, but fraudulent accounting allows the monopolies to pollute and destroy the environment without having to pay for the clean up.

Posted by Kevin Schmidt on 2013-11-02 17:25:05

It's the Democrats' fault for not eliminating the filibuster. They had several chances to do so, but refused. That makes the Democrats obstructionist enablers, which means they are just as guilty of obstructionism as the Republicans.

Posted by Kevin Schmidt on 2013-11-02 17:23:23

Alas, "Single Payer" health insurance was (and still is) not a feasible plan to get passed by both Houses due to the obstructionism of the GOP. Even when the Democrats had a clear majority in both Houses, Republicans in the Senate invoked and abused the filibuster to block discussion and debate on any legislative proposal that they deemed "unAmerican".

Posted by labman57 on 2013-11-02 16:01:56

As long as they have power. And the elites will do anything to keep power.

Posted by Michelle Black on 2013-11-02 13:38:24

How long can a society that puts profit over everything exist?

Posted by Pelu Maad on 2013-11-02 13:21:35

It is near impossible for normal people to work up sufficient cynicism to even begin to understand our rulers. Here is a wonderful example, a program originally opposed by Nixon, refined by the Heritage Foundation, first enacted by Governor Romney. And now presented by the most conservative of all Democrats, Barack Obama.

The only force strong enough to overcome graft in Washington is the racism of the Right.